DESCRIPTION: (Applicant's Description) As a general internist with training in clinical epidemiology, David A. Katz, M.D., M.Sc. is an excellent candidate to fulfill the goals of the Preventive Oncology Academic Award (POAA). His professional focus is the evaluation of practice guidelines and clinical practice policies; in particular, he has a strong commitment toward research in tobacco control and cancer prevention. Improving the evidence base for practice guidelines and devising novel ways to implement them is especially pertinent for the POAA, as guidelines have great potential to improve the overall delivery of cancer prevention clinical care. Along these lines, the research goal of this proposal is to complete a controlled intervention trial, involving consecutive outpatient smokers presenting to ten primary care clinics. This research is designed to determine the effectiveness of utilizing non-physician staff to implement the Agency for Health Care Policy and Research (AHCPR) Smoking Cessation Clinical Practice Guideline. In this trial, intake clinicians (medical assistants and practice nurses) will be trained to perform systematic identification of smoking status, to offer brief cessation counseling, and to arrange follow-up. Major endpoints will be 1) the proportion of smoking patients who receive recommended guideline interventions, and 2) self-reported and biochemically confirmed cessation rates. The educational goals of this proposal are 1) to augment Dr. Katz's training in areas pertinent to preventive oncology, including design of effectiveness trials, biostatistics, and smoking cessation in clinical practice, and 2) to expose Dr. Katz to national intervention studies in cancer prevention and tobacco control. Dr. Katz will devote 100 percent of his efforts toward the goals of the POAA. His proposed research will provide much needed evidence on the effectiveness of a national smoking cessation guideline in clinical practice, as well as more general insights into the utilization of guidelines to improve preventive care. Dr. Katz will fulfill the intent of the POAA in providing an opportunity for individuals already proficient in epidemiology to make the transition to a fully independent investigator and teacher in cancer etiology, prevention, and control.